Diagnosis & Treatment of CD Update

By Alex Reis PhD, GFT science writer

What are researchers up to?

Celiac disease has long been the subject of research in many different studies. In the past, researchers have focussed mainly on learning the key facts about this condition, looking for a deeper understanding about its genetic and molecular basis. This type of research is still on-going, but the wealth of information researchers have amassed over the past few years is now being put to good use, as scientists attempt to make celiac patients’ lives a little easier: a more accurate diagnosis and potential ways to “escape” a gluten-free diet.

Better ways to diagnosis?

Celiac disease is not the easiest condition to diagnose. Endoscopy is one of the most used diagnostic tools but, even for a trained eye, the poor image resolution make detection of subtle changes an almost impossible task. However, riding the wave of recent advancements in software and hardware technologies, researchers are set on changing this and develop better imaging tools.

Recent efforts, for example, have looked at the possibility of using computer-assisted automated analysis, which not only eliminates bias from different observers but also makes detection of minimal changes much more rigorous. In addition, ways to increase image resolution also feature high on the agenda, including how to apply high-resolution magnification endoscopy and chromoendoscopy to the diagnosis of celiac disease, as well as developing new software allowing for tone, texture and colour enhancement, creating an image bursting with detail.

Thinking “outside the digestive tract”, researchers are investigating whether it can be possible to diagnose celiac disease using less invasive methods. One recent example requires a simple urine sample, which is then tested for volatile organic compounds. The method is still in its infancy, but this approach seems to offer a viable alternative to diagnose celiac disease, and researchers were even able to distinguish between patients with celiac disease and IBS.

The fact that a small spleen is characteristic of patients with celiac disease gave researchers the basis for another potential test to diagnose the condition. A preliminary study identified 80% of celiac disease patients have a small spleen, compared to only 9% for IBS patients. Researchers suggest its use not to obtain a final diagnosis, but to identify patients potentially at risk of having celiac disease.

Currently, diagnosis also relies on many serologic tests. However, these are not a direct measurement of intestinal changes, but instead reflect how the body reacts to the inflammation. To overcome this limitation, researchers are attempting to develop more direct assays, such as testing for intestinal fatty-acid binding protein, which could be used alongside current methods to provide a more detailed “picture”.

In fact, it’s not unreasonable to say that the coming years hold much promise for the continuing development of imaging- and serum-based tests to be used in the diagnosis of celiac disease, potentially leading to significant improvements in patient care.

Is there a new treatment on the horizon?

Once diagnosed, a gluten-free diet is the only option for celiac disease patients, and will remain so for the foreseeable future. That doesn’t stop patients dreaming about the much-wanted opportunity to be free from the “shackles” of a constant battle to wipe out gluten from their diet.

Researchers are not there yet, but work is in hand to develop potential alternative treatments. Things may change in the future but, sadly, it’s clear at this stage these will not become a true alternative to a gluten-free diet. Nevertheless, despite still being a few years away, their release to the general public is already a much awaited event, as they will, at least, enable patients to ease their nutritional restrictions.

The first option is to stop gluten in his route of devastation as soon as possible. Gluten is naturally resistant to enzymatic activity in the digestive tract, but researchers have found cunning ways to increase its digestibility, reducing the danger of activating an immune response. The trick is remarkably simple: a pill containing a mixture of enzymes that can degrade gluten to non-toxic fragments. This approach has been studied for some time now, and it’s possibly one of the most advanced treatments potentially available to patients in the next few years.

The other side of the coin is to make gluten even more indigestible, by attaching it to a long-chain polymer. This idea is still in the early stages, but recent in vitro studies show promising reductions in the digestion of gluten.

Tackling the issue in various fronts, researchers don’t limit themselves to gluten. Another approach currently enjoying some success is the use of inhibitors to target specific compounds involved in the immune response triggered by gluten.

One example is zonulin. Once it hits the digestive tract, gluten activates the release of this protein, and in turn, zonulin increases the permeability of the intestinal walls. This allows gluten to sneak out of the intestines and inevitably trigger an inflammatory response. The zonulin inhibitor is called larazotide acetate and so far its use in clinical trials has shown an admirable ability to close the “doors” and trap gluten inside the boundaries of the intestine. This potential treatment is also in advanced stages of development, and it’s highly likely to be available in the near future.

Another important target is the enzyme responsible for degrading specific amino acids present in gluten. This enzyme is called transglutaminase, and it represents the first step in activating the immune response. Not surprisingly then, researchers have tried to stop the activity of this enzyme. However, what started as a brilliant idea soon turned into a frustration, as the same enzyme is also responsible for other important metabolic functions in the body. Not giving up, researchers are now working on ways to develop specific transglutaminase inhibitors that are active only in the digestive tract, but do not affect anywhere else in the body.

Finally, what many believe to be the Holy Grail of celiac disease treatment is a vaccine to prevent the immune response caused by gluten. A vaccine containing a combination of several key peptides present in gluten is currently being tested in clinical trials, after promising results in small-scale studies showing it can induce tolerance to gluten in celiac disease patients.

Celiac disease may not be the easiest condition to diagnose and treat, but researchers continuously strive to find better diagnostic tools and treatments. What’s coming next? Watch this space!

This original article is made possible by Gluten Free Therapeutics. Our mission is to educate, inform, and provide the most effective nutritional products possible to allow those with celiac disease and serious gluten intolerances to heal their bodies. CeliVites complete line of superior gluten free supplements includes multivitamin/multimineral supplements, iron supplements, and calcium supplements for people living with celiac disease. All CeliVites products are designed to help you heal, restore and rebuild your body, because going gluten free isn’t enough! 

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